Objectives: Compare induction to delivery intervals and complications in second trimester labor induction using mifepristone with misoprostol vs misoprostol alone.
Methods: A retrospective analysis was performed of second trimester induction terminations at two urban medical centers over ten years. Inclusion criteria were pregnancies between 14.0 weeks and 23.6 weeks gestation without evidence of labor, intrauterine infection, or ruptured membranes upon admission. Comparisons between mifepristone plus misoprostol or misoprostol alone were performed, including composite complications (retained placenta requiring surgery, infection, hemorrhage, blood transfusion, failed induction, ICU admission, and readmission), total misoprostol dosage, and induction to delivery intervals.
Results: The final analysis included 406 patients, 286 (66%) at gestational age > 20 weeks. Most were for fetal anomalies (196, 48.3%) or intrauterine fetal demise (199, 49.0%). Twenty-two percent (n=92) had a prior cesarean section. Thirty-two percent (n=133) received mifepristone plus misoprostol and sixty-seven percent (n= 273) received misoprostol alone.
Time from first dose of misoprostol to delivery of fetus were similar between patients treated with mifepristone plus misoprostol (14.6h) vs misoprostol alone (14.1h, p=0.63) as were rates of completed abortion within 24h (84.2% vs 86.7%, p=0.53). Total complication rates were similar between treatment groups (19.6% vs 28.6% p=0.51); however, D&C for retained placenta occurred less frequently with mifepristone plus misoprostol as compared to misoprostol alone (3.8% vs 17%, p=0.0001).
Conclusions: In a cohort that includes induced abortion and intrauterine fetal demise, adding mifepristone prior to misoprostol for second trimester induction results in fewer retained placentas requiring surgical management but does not change time to complete abortion.
© 2021 Published by Elsevier Inc.